title: Trends in the outcomes of percutaneous coronary intervention with the routine incorporation of fractional flow reserve in real practice.
abstract: OBJECTIVE
  We evaluated the impact of the routine use of fractional flow reserve (FFR) on the practice and outcomes of percutaneous coronary intervention (PCI).
  
  
  RESULTS
  Between January 2008 and December 2011, the rate of FFR use during PCI increased from 1.9 to 50.7% after the introduction of routine FFR use (P < 0.001). A total of 5097 patients (2699 patients before and 2398 after the routine use of FFR) underwent PCI at an academic hospital in Korea; of those, stent implantation was deferred in 475 patients. We used propensity score (PS) matching to compare the rates of the primary endpoint [death, myocardial infarction (MI), or repeat revascularization] at 1 year the cohort before and after the routine use of FFR. In the PS-matched cohort (2178 pairs), the median number of lesions per patient was 2 [inter-quartile range (IQR) 1-2] before vs. 2 (IQR 1-2) after the routine FFR use (P = 0.68); the median number of stents implanted per patient was 2 (IQR 1-3) vs. 1 (IQR 1-2), respectively (P < 0.001). The rates of the primary endpoint at 1 year was significantly lower in patients after the routine FFR use vs. patients before the routine use of FFR (hazard ratio 0.55; 95% confidence interval 0.43-0.70; P < 0.001). This was primarily due to a reduction in peri-procedural MI and repeat revascularization.
  
  
  CONCLUSIONS
  Routine measurement of FFR in daily practice appeared to be associated with less use of stents and an improvement in clinical outcomes.
  NCT 01788592.
authors.affiliation: Heart Institute, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.forename: Gyung-Min
authors.initials: GM
authors.lastname: Park
authors.forename: Young-Rak
authors.initials: YR
authors.lastname: Cho
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Won-Jang
authors.initials: WJ
authors.lastname: Kim
authors.forename: Seungbong
authors.initials: S
authors.lastname: Han
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
mesh_terms: D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D057216:Propensity Score; D011446:Prospective Studies; D015607:Stents / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Coronary Disease; Fractional Flow Reserve; Prognosis; Stents